전문간호사 제도와 무면허 의료행위 - 대법원 2010.3.25. 선고, 2008도590 판결 중심으로 -

김경례 대한의료법학회 2010 의료법학 Vol.11 No.1

There is a system in Korea named “Advanced Practice Nurse System” qualified by the Minister of Health, Welfare and Family Affairs for Advanced Practice Nurse besides nurse licence. Medical practice is, in today's medical law, understood as a general concept colligating medical practice, nursing practice and midwife practice and so on, for it is defined as a deed of medical technique practiced by medical personnel. Referring to the fact that the Supreme Court recognizes medical personnel as people who have medical expert knowledge, nursing practice can be recognized as a region of medical business and therefore it is not necessary to prescribe nursing practice separately from the definition of medical practice on a precedent, because nurse belongs to medical personnel. According to the precedent regarding ‘Unlicensed Medical Practice of Advanced Practice Nurse for Anesthesia’ recently sentenced by the Supreme Court, the medical practice is only allowed a doctor because it is ‘in need of special knowledge and experience because of high danger on human body' and it is judged to be an unlicensed medical practice prohibited in medical law if it is to be done by a nurse. When considering the actual situation that System for Advanced Practice Nurse for Anesthesia is established under the circumstance that an anesthetist is in want and therefore the operation has not been performed on time, and that it is being expected an anesthetist to be in need, it is necessary to legislate for the range of medical practice of Advanced Practice Nurse so that Advanced Practice Nurse System can be practically legalized, for the role of Advanced Practice Nurse has the great possibility of shrinking because the precedent has considered Advanced Practice Nurse for Anesthesia doing anesthetic operation in clinic today as a potential wrongdoer.

응급전문간호사의 전문가적 실무수행 분석

김진현,김명애,김미원,김경숙,유정숙,이은희 한국자료분석학회 2010 Journal of the Korean Data Analysis Society Vol.12 No.2

Purpose : The purpose of this study was to analyze the advanced nursing practice in emergency department used frequently by Korean ENPs and to provide basic data in order to develop nursing fee of the health insurance. Method : Practices of emergency nurses were differentiated into RN's and ENP' practices by panel of emergency nursing experts. Each Practice of ENP was defined. General hospital of Seoul where ENP is being worked, nurse practice time and frequency were checked. Result : Practice of ENP were classified 6 domain of 27 practices. Each Practice was defined and presented as step of procedure. 18 practices were completed in 10 minutes and the other 9 practices were completed from 10 to 30 minutes. Priority of performance was triage, ECG check, IV insert, blood culture and ABGA. Conclusions : ENPs carried out advanced nursing practice. Some of ENP practice were differentiated from that in RNs. It is necessity to enhance and develop other advanced practice. In order to expand of advanced nurse practitioner in system, it is necessary to evaluate economic value of advanced nursing. 본 연구는 우리나라 응급의료체계에 새로 도입된 응급전문간호사의 업무를 명확히 하기 위한 목적으로 시도되었으며, 이를 위해 응급전문간호행위를 조사하여 분류하고, 이에 대한 실제 관찰을 통해 수행 시간측정과 빈도조사를 시행하였다. 그 결과 27개의 응급전문간호행위가 분류되었으며, 이들 행위별 정의와 수행절차가 기술되었다. 응급전문 행위에 대한 관찰 결과 27개 전문간호행위의 시간 범주는 30분 이내에 있었으며, 그 중 18개의 행위는 10분 이내로 측정되었다. 수행빈도 측정결과 읍급전문간호사들이 임상에서 주로 수행하고 있는 업무로 상위 5위에 해당하는 행위는 ‘중증도분류’, ‘심전도검사’, ‘정맥로 삽입’, ‘혈액배양검사 관련 간호’, ‘동맥혈가스분석검사시 채혈과 판독’으로 나타났다.

종양전문간호사의 노인 암환자 케어 코디네이션 경험에 관한 내용분석

박미란(Mi-ran Park),염혜아(Hye-Ah Yeom) 학습자중심교과교육학회 2022 학습자중심교과교육연구 Vol.22 No.11

목적 본 연구는 케어 코디네이션을 통한 의료의 질 향상을 위해 노인 암환자에게 케어코디네이션 서비스를 제공한 종양전문간호사의 경험을 분석하였다. 방법 참여자는 노인 암환자에게 케어 코디네이션 서비스를 제공한 경험이 있는 종양전문간호사 6명으로 개별 심층 인터뷰를 하였다. 자료수집은 2017년 9월 18일부터 2018년 2월 2일까지 진행되었다. 수집된 자료는 Krippendorf의 질적 내용분석방법을 적용하여 분석하였다. 결과 분석 결과 30개의 주제, 14개의 주제 모음, 5개의 범주가 확인되었다. 5개의 범주는 ‘노인 암환자의 특성 고려’, ‘치료 전반을 함께하는 동반자로서의 전문간호사’, ‘전문간호사 역할에 대한 자부심’, ‘전문간호사의 성장을 위한 과제’, ‘노인 암환자를 위한 시스템 개선 방향’이 도출되었다. 결론 본 연구결과를 토대로 노인 암환자에게 통합적인 의료서비스를 제공하기 위해서는 전문간호사의 케어 코디네이션 서비스의 이점을 인식해야 할 것이다. 이와 함께 종양전문간호사의 역량을 높이기 위한 지속적인 지원과 다학제간 협조도 강조되어야 한다. Objectives This study aimed to analyze the experiences of oncology advanced practice nurses who provided care coordination services to elderly cancer patients. Methods This study was a descriptive study using content analysis method. Six oncology advanced practice nurses recruited from a University hospital were interviewed in-depth about their experiences of providing care coordination for elderly cancer patients. Data collection was conducted from September 18, 2017 to February 2, 2018. The data were analyzed using Krippendorf’s qualitative content analysis method. Results As a result, 30 themes, 14 themes clusters, and 5 categories were identified from the in-depth interviews. The 5 categories were ‘considering the characteristics of elderly cancer patients’, ‘advanced practice nurse as a partner for overall cancer treatment process’, ‘pride in the role of the advanced practice nurse’, ‘tasks for improvement of advanced practice nurse service’, ‘strategies for the improvement of nursing care for elderly cancer patients’. Conclusions Based on the results of this study, it is concluded that the benefits of care coordination service by advanced practice nurses should be recognized to provide more integrated healthcare services for elderly cancer patients. Consistent support and multidisciplinary collaboration should also be emphasized to increase the competency of advanced practice nurses in the field of oncology nursing.

Legislation of Medical Support Tasks in the Nursing Act as a Foundation for Nursing Professionalism and Role Expansion

Su Jung Choi 한국성인간호학회 2025 성인간호학회지 Vol.37 No.2

Purpose: This study aimed to suggest directions for legislation regarding medical support tasks in the Nursing Act to promote the advancement of nursing. Methods: This study reviewed the history of medical support nurses in South Korea and the educational programs for advanced practice providers, both domestically and internationally. Results: Nurses have performed medical support tasks traditionally carried out by physicians, but legal controversies have persisted. As a result of the escalation of conflicts surrounding policies aiming to increase the physician workforce, training doctors left hospitals. This prompted the initiation of pilot programs allowing nurses to legally engage in medical support tasks, culminating in the enactment of the Nursing Act in September 2024. Internationally, advanced practice providers such as advanced practice nurses (APNs) and physician assistants (PAs) undergo graduate-level education and certification. Since Korea lacks a PA system, integrating medical support tasks within the APN framework would be preferable. Achieving this will require absorbing clinical practice nurses (referred to as PA nurses) into the APN system, implementing government-supported education programs to address regional disparities, and establishing reimbursement policies for APNs. Conclusion: With the implementation of the Nursing Act, a long-term approach is needed to establish professional qualifications, accreditation, education, training, examination, and regulatory systems. A comprehensive discussion should be undertaken to develop an optimal workforce, ensuring the delivery of safe and high-quality healthcare services to patients and the public.

Adoption of Evidence-Based Practice-Advance Directives in Nursing Homes

( Juh Hyun Shin ),( Dong Eun Jang ) 이화간호과학연구소 2016 Health & Nursing Vol.28 No.2

Purpose: Nursing homes commonly experience the death of residents, family members, and staff. The strategies to protect nursing home residents` autonomy at the end of life are very important. However, current end-of-life care procedures have been limited and too abstract. Many nursing home residents die without the opportunity to express their intentions. Residents` autonomy in the decision-making process in long-term care settings has been limited. This article explored the urgent problem of end-of-life care in nursing homes, as well as the advantages of and barriers to advance directives. Methods: By reviewing articles, this study has introduced and discussed Evidence-based practice-advance directives developed by the Gerontological Nursing Interventions Research Center, University of Iowa. Results: The benefits of advance directives are that the residents get the care that they want and need without losing the right and autonomy to make their own choices regarding future treatment. A major barrier to completing advance directives is that many NH residents are cognitively impaired. Conclusion: EBP-ADs have the advantage that we can expect an increased AD-completion rate with the use of EBP in nursing homes. Also, EBP-ADs can be purchased at a reasonable price, are systematically developed, and concise and easy to use.

종양전문간호사 프로그램의 실습교과 운영현황 및 방향

박정숙(Park, Jeong Sook),박정윤(Park, Jeong Yun),최자윤(Choi, Ja Yun) 대한종양간호학회 2015 Asian Oncology Nursing Vol.15 No.4

Purpose: This study was conducted to identify the present conditions of clinical practicum through analyzing guidebooks used in education institutions for oncology advanced practice nursing programs and to discuss future directions. Methods: Ten of a total of 13 education institutions participated in this study and ten guidebooks were reviewed from June 1 to October 31, 2014. The standard curriculum developed by the Korean accreditation board of nursing education was used to analyze the present conditions and an analyzing frame was developed by a research team. Two coders independently recorded the data, agreement was 92% and all disagreements was concurrent after discussion. Results: Courses in the area of ‘advanced oncology nursing’ were most highly established and, courses in the area of ‘introduction of oncology nursing’ were least established. Some learning objectives were never dealt with and some learning objectives were over dealt with. The national cancer center was most used for practicum. Diverse homework and evaluation methods were used. Conclusion: Through analyzing clinical practicum guidebooks for oncology advanced practice nursing students, we found that balanced practicum courses are needed to improve the quality of oncology advanced practice nurse programs.

국내 전문간호사 관련 연구 동향분석 (2014년∼2024년)

박선정(Sun Jung Park),황예인(Ye In Hwang),김보경(Bo Kyung Kim),박해민(Hae Min Park),곽근혜(Keun Hye Kwak) 한국건강간호융합학회 2024 한국건강간호융합학회지 Vol.1 No.2

Purpose : The purpose of this study is to examine the research trends related to advanced practice nurses in South Korea over the past 10 years and to provide foundational data for promoting the advanced practice nurse system. Method : This descriptive survey study analyzed articles on advanced practice nurses published in Korean academic journals from 2014 to 2024. Results : Key topics related to advanced practice nurses in South Korea include delegation intent (2 articles, 8%), experiences of healthcare professionals (2 articles, 8%), and the following topics, each represented by one article (4%): perception of legalizing advanced practice nurse roles, factors influencing political competence, impact on clinical nurses' perception, examination of future prospects, leadership experiences, impact on spiritual nursing practices, difficulties and coping strategies in clinical practice, studies on structuring advanced practice nurse specialties, impact on self-concept, legal consistency studies, nursing law proposals, legal issues in proposed amendments, current status and vitalizing strategies, job experiences, roles, qualitative analysis of counseling content, frequency and importance of tasks, patient satisfaction, curriculum comparison, comparison of empowerment and job satisfaction with organizational commitment, and mediation effects of role clarity. Conclusion : Considerable attention and research are required to ensure the stable activation of the advanced practice nurse system, allowing for individualized care and high-quality healthcare services to be provided to patients.

종양전문간호사의 간호중재 효과: 체계적 문헌고찰

김현주,서은주 대한산업경영학회 2024 산업융합연구 Vol.22 No.11

본 연구는 종양전문간호사의 간호활동을 확인하고 그 효과를 확인하기 위하여 체계적 문헌고찰을 실시하였다. CINAHL, Medline, DBpia, KISS, RISS를 통해 논문을 검색한 결과 총 641편의 논문이 검색되었으며, 최종 5편의 논문이 최종 분석에 포함되었다. 종양전문간호사가 제공하는 간호중재는 전화를 통한 연락, 환자 진단, 조언, 질문 응대, 환자 사정, 질병과 관련된 증상 정의, 가정 방문 간호가 있었다. 간호중재 효과를 살펴본 결과 불안, 우울이 감소하고, 삶의 질, 간호에 대한 만족도가 높았으며, 의료비용이 감소하는 것으로 확인되었다. 본 연구 결과가 추후 국내 종양전문간호사의 역할 및 업무를 위한 기초자료로 활용될 것을 기대한다. This study conducted a systematic review to identify the nursing activities of oncology advanced practice nurse and determine their effectiveness. A total of 641 articles were retrieved through CINAHL, Medline, DBpia, KISS, and RISS, and five articles were included in the final analysis. The nursing interventions provided by oncology advanced practice nurse included telephone contact, patient assessment, advice, answering questions, patient assessment, defining disease-related symptoms, and home visits. The results showed that the nursing interventions reduced anxiety and depression, improved quality of life, satisfaction with nursing care, and reduced medical costs. The results of this study are expected to be used as a basis for the role and work of oncology advanced practice nurse in Korea.

임상전문간호사 운영 현황 및 역할 조사

권인각,김연희,황경자,김혜숙,이봉숙,이혜숙,최원자 병원간호사회 2003 임상간호연구 Vol.9 No.1

Purpose: In this study, we investigated hospitals in Korea that comprised more than 400 beds and attempted to understand the present state of Advanced Practice Nurses (APNs and below) from 11 different fields (Diabetic education, Wound-Ostomy, Neurology, Neonatal, Cardiovascular, Oncology, Emergency, Organ-transplantation, Renal, Critical care, and Hospice). We also compared and determined the time spent on the role of each nurse from each field and the frequency of implementation for each work activity. Method: This study was conducted from July 2002 to May 2003. Data from 299 nurses that responded to the survey from 57 hospitals were analyzed with descriptive statistics, chi-square test and t-test using SPSS 10.0 program. Result: Out of 299 nurses that responded, 137 nurses from 35 hospitals were officially appointed as advanced practice nurses and assumed the duties of advanced nursing practice. The remainder of the nurses were not suitable to be classified as APNs. From the fields of neurology, cardiovascular and oncology, 25~31 APNs were found respectively, amounting up 63% in total. No APNs were found in the fields of critical care and renal. Mean percentage of time spent on each role was 42.8% for direct practice, 27.7% for education, 13.2% for consultation and coordination, 8.9% for research and 6.5% for administration. Amongst the work activities of all APNs, the activities that were most frequently implemented included reading of examination results, psychosocial assessment, consultation and education for the patients and their families, managing treatment, writing up patient records, history taking, consultation for nursing staff, physical examination and triage. Although not frequently performed, nurses in some fields carried out invasive procedures and prescribed medications or tests. Conclusion: Although the number of APNs are rapidly increasing in hospitals, there is yet confusion with regards to the title and classification of APNs, as well as the distribution of roles. Thus, there is an urgent need to establish a systematic framework as well as standards. Furthermore, because some nurses are prescribing medication for patients as well as performing techniques not traditionally handled by nurses, there is an absolute need for a legalized and systematic education system for the safety of patients who are being cared for by these nurses as well as all APNs.

간호업무 관련 법령의 정합성 연구: 간호사, 조산사, 전문간호사, 간호조무사를 중심으로

김민지 ( Kim Minji ),김인숙 ( Kim Insook ),이유리 ( Lee Yuri ) 한국보건사회연구원 2018 保健社會硏究 Vol.38 No.3

Related to nursing services, the Medical Services Act was amended in December 2015 and the grounds of advanced practice nurse’s qualification was ruled in the law in March 2018. Although legislations related to nursing services have been modified constantly, there remain problems of nursing staffs those are not covered enough by current legislations. The purpose of this study was to review nursing services laws and regulations, especially for nurse, midwife, advanced practice nurse and nurse assistant and to examine legal coherence among them. There are 14 acts that have provisions related to nursing services. In terms of completeness there is no regulation about nursing services of advanced practice nurse. With respect to consistency there is contradiction among legislations provisions in the Medical Service Act and those in other health laws regulating nursing services. Based on analysis of horizontal coherence, confusion may occur because legislations exist sporadically which causes different interpretation. Vertical coherence analysis shows absence of some lower statutes in spite of the delegation. This study suggests two ways to enhance coherence. One is to maintain current legislations while amending the provision preventing them coherent. The other is to enact the unified Nurse Act. This study is meaningful as there is only few preceding research on legal coherence in health system.